Intro to Critical Care - Block 4 Flashcards
What types of acute organ dysfunction fall under ICU?
- Shock
- Sepsis
- ADHF
- Acute tox
- Status epilepticus
- Stroke
- End organ damage from chronic dx
Who are closely monitoring the ICU?
- Trauma
- High risk surgeries (CABG, neurosurgical)
- High risk bleeding
What are the phases of crit illness?
- Rescue
- Optimization
- Stabilization
- De-escalation (step-down)
Route of med most common in ICU?
IV route:
1. Predicatable F
2. Fast onset
3. Rapid titratability
4. Wide therapeutic window
How is absorption affected in crit patients?
- Perfusion deficits
- Dysmotility
- Altered pH
- Loss in bowel integrity (perforation)
- Peripheral/gut edema
- Regional blood flow
Changes in Vd is affected by?
- FLuid shifts
- Tissue perfusion
- PPB
- Reduced tissue perfusion decreases distribution of hydrophilic medications
- Lipophilic (lipid-soluble) medications penetrate well into tissues independent of blood flow
What is shock liver?
Hypoxic hepatitis:
1. Acute cardiopulmonary failure
2. Transient increase in serum aspartate or alanine aminotransferase
3. Exclusion of other etiologies
When is augemented renal clearance used?
CrCl >120-160
How is distribution affected in crit patients?
- Largevolume resuscitation
- Capillary leak syndrome
- Ascites
- Mechanical ventilation
- Hypoalbuminemia
- ECMA
- Decreased a1 acid glycoprotein
How is metabolism affected in crit?
- Hepatic enzyme induction
- Augmented hepatic blood flow
- Hepatic enzyme inhibition
- Decreased hepatic blood flow
How is excretion affected by crit?
- Augmented renal clearance
- Extracorporeal removal
- AKI
What is MODS?
Potentially reversible physiologic derangement involving 2 or more organ systems not involved in disoder that resulted in ICU
What are you vital organs for survival?
Brain, kidney, heart, lung, liver
How do you interpret MOD score?
↑ MOD -> ↑ organ damage and mortality
MOD score of 0 is the best, 4 is the worst
How do you calculate R/P ratio?
(HR x right atrial pressure)/MAP
CV MODS description?
- Decreased peripheral vascular tone
- Increase capillary permeability 0> edema
- ALteration in regional bloof flow
- Microvascular plugging and stasis
- Myocardial depression
Lung mods description?
Failure of normal gas exchange
Kidney mods description?
Impariment in excretion
Immunologic MODS description?
nosocomial ICU-acquired infection
Prevention of MODs in lungs?
Ventilation
Prevetnion of MODS in CV?
Restrict transfusion of packed red cells when hemoglobin is > 70
MOD prevention in renal?
Avoidance of nephrotoxins
Prevetnion of MODS in GI?
Stress ulcer prophylaxis with H2 blockers rather than sucralfate
Enteral nutrition
MOD prevention in hematologic?
DVT prophylaxis
What are inhaled meds for respiration? Advantages?
Bronchodilators (Combivent - Ipratropium/Albuterol), steroid, abx
- Rapid onset
- high lung tissue drug concentrations
- Limited tox
- No IV
What is you most invasive way of delivering O2 to a patient?
Ventilation
What is the sequence ofdrug in rapid sequence intubation?
- Sedative always goes first
- Neuromuscular blockers as a paralysis agent
What are ex of continuous organ support?
Establishes a new steady state:
1. CRRT
2. ECMA
What is an ex of intermittent organ support?
Changes medication dispostiton and elimination:
1. HD
2. TPE
3. ELSS
What is ECMO?
Bypasses lungs: Deoxygenated blood is brained from the superior vena cava, pumped through and oxygenator, and delivered back into the body through the femoral artery
What is TPE?
Plasma exchange that is a closed-circuit blood purification system that removes large molecules
How are medications affected by TPE?
Alters the volume of distribution, protein binding, and clearance of a medication:
1. Human albumin replacement can increase the fraction of protein-bound medications
2. Removes drugs present in plasma
What is ELSS?
Extracorporeal Liver Support System: dialysis for failing liver -> allow hepatocytes to recover or temporize until liver tranplants
What are the components of an ICU check up?
Feeding
ANalgesia
Sedation
Thromboembolism prevention
Head of the bed elevation
Ulcer prophylaxis
Glucose control
Spontaneous breathing trial
Bowel function evaluation
Indwelling catheters (removal)
De-escalation of antimicrobial and other pharm
What is PICS?
Post intensive care syndrome: complication of ICU surviorship where assessment is recommended within 2-4 weeks of discharge
